All hail the toilet!
Last month on November 19th the global health and development community celebrated World Toilet Day. A day dedicated to honoring a bathroom fixture as ubiquitous as the toilet might seem trivial and unwarranted among Western households; but to the 2.4 billion people worldwide who do not have access to proper sanitation, the toilet is a luxury that can mean the difference between a healthy family and a sick family.
The 2015 theme for World Toilet Day was “Sanitation and Nutrition,” and it coincided with the release of a joint report from UNICEF, the United States Agency for International Development (USAID) and the World Health Organization (WHO) entitled Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene. The report compiles years of research and case studies underscoring the link between WASH and nutritional status and provides guidance on effective interventions. As the evidence base grows, the need to incorporate WASH (water, sanitation and hygiene) programming into maternal and child health interventions has become increasingly more critical.
What is WASH and how does it impact health?
The field of WASH addresses water (e.g. water quality, water quantity), sanitation (e.g. open defecation, clean households) and hygiene (e.g. hand-washing with soap) and the numerous deleterious health risks associated with inadequate WASH services. One of the most insidious and common culprits associated with poor WASH is diarrheal disease. Each year diarrhea kills 760,000 children worldwide making it the second leading cause of death for children under five and the leading cause of malnutrition. Fortunately, diarrhea is both treatable and preventable; but without access to clean drinking water, proper disposal of feces, and a clean environment for children to thrive – preventing recurrent diarrhea can be a challenge.
Diarrhea is not a new phenomenon and it is certainly not unique to low income countries; but the absence of WASH infrastructure in many developing parts of the world is what permits fecal pathogens to spread easily and infect humans. In the absence of proper latrines or hand-washing stations, fecal pathogens can easily contaminate drinking water or pass from person to person through the handling of food or casual contact. Young children are especially susceptible to fecal pathogens and helminth infections (parasitic worms), and frequent fecal-oral contamination can lead to a gut altering condition known as environmental enteropathy. Environmental enteropathy causes structural changes in the small bowel that cause impaired functioning and an inability to effectively absorb nutrients. According to a 2012 study by Korpe and Petri entitled Environmental Enteropathy: Critical implications of a poorly understood condition, “the most significant impact of environmental enteropathy may be on malnutrition, a well-recognized problem in the developing world where 26% of children under age five are underweight.”
How Barakat Bundle Addresses WASH in Infants
WASH interventions have the potential to disrupt the transmission of fecal pathogens to a human host and subsequently prevent hundreds of thousands of cases of diarrhea each year. Barakat Bundle addresses both the prevention and treatment of diarrhea by incorporating evidence based WASH interventions that specifically target children during the critical first year of life.
Young children are known for curiously grabbing any object within arm’s reach and placing it directly into their mouths. In cases when infants play outside on the ground, often while their parents tend to household chores or agricultural activities, they frequently come in contact with the feces of poultry and livestock. Children often directly handle and ingest the feces (chicken poop constituting a major culprit) creating a direct line for fecal-oral contamination that can subsequently cause diarrheal disease. A 2013 study in Zimbabwe directly observed 21 households with children 6-18 months old for 6 hours each and found that infant hands were put into the mouth an average of 38 times during the observation period and that the hands were visibly dirty 75% of the time. The researchers posit that exploratory ingestion of soil and chicken feces had the greatest risk of fecal bacteria exposure.
Barakat Bundle specifically addresses the issue of a sanitary play environment for infants by doubling as a protected play space. By creating a contained barrier between the dirty ground and the infant, Barakat Bundle can reduce direct exposure to fecal contaminants that cause environmental enteropathy. In the instance that a child still experiences diarrhea, however, Barakat Bundle also provides caretakers with oral rehydration salts to hydrate the infant and restore balance to their system.
The first year of life provides a critical window of time to foster a child’s health and development. Preventing recurrent diarrhea and exposure to environmental contaminants through WASH interventions, such as a clean play space, helps to improve a child’s nutritional status and overall health. Barakat Bundle is excited to address WASH in its cadre of services to mothers and infants in South Asia and add to the evidence base of effective infant and young child WASH interventions.
 Korpe, Poonum S., and William A. Petri. “Environmental enteropathy: critical implications of a poorly understood condition.” Trends in molecular medicine 18.6 (2012): 328-336.
 Ngure, Francis M., et al. “Formative research on hygiene behaviors and geophagy among infants and young children and implications of exposure to fecal bacteria.” The American journal of tropical medicine and hygiene 89.4 (2013): 709-716.